Pete Wedderburn

Pete Wedderburn qualified as a vet twenty-five years ago, and now spends half his working life writing newspaper columns. He lives in Ireland with his wife, two daughters and a menagerie of dogs, cats, poultry and other furry and feathered companions. Pete answers readers' queries about their pets' health in his video Q&A – he is also on Twitter as @petethevet and has a Facebook Fan Page.

Quality of life: how should it be measured?

QOL is an odd acronym: how should it be pronounced? It’s an important subject, both in human and veterinary medicine: Quality of Life may be the single most important measurement of patients under the care of doctors and veterinarians. If the QOL score is high, then the treatment is working and life is worth living. If it’s low, then the treatment needs to be reviewed, and indeed, in the veterinary world with an elderly or terminally ill animal, the subject of euthanasia may be on the agenda.

QOL is a central component of veterinary practice, but to date, it’s been almost entirely subjective; part of the “art” of being a veterinary surgeon. The most common time that it’s discussed is when an elderly animal is drawing close to the end of its life. The vet, together with the animal’s owner, discusses QOL, using simple ideas that can be very useful. “Write down ten things that he used to enjoy doing. If he isn’t doing more than three of them any more, perhaps it’s time for him to go”. At other times, an even more purely subjective assessment can be used: “Have a conversation with him: ask him if he’s ready to go.”

This vague method of assessing a critically important measurement may soon be superceded by the type of objectivity that’s becoming common in human medicine. QOL is now recognised as a new veterinary “discipline”, with vets choosing to specialise in the subject, drawing up structured methods of QOL assessment that can be used to assist clinical decision making.

In humans, it’s relatively easy: patients can be asked questions about their happiness, their subjective sense of well-being and their life satisfaction. With animals, whilst it can be useful to ask owners about their impression of these aspects of their pets’ lives, it’s also helpful to measure parameters that can be directly observed. QOL questionnaires are now available that objectively assess the resources provided for pets (comfort, exercise, diet, mental stimulation and companionship) as well as attempting to place a score on a range of behavioural and medical signs. The aim is to enable clearer assessments about the success of treatments being given (e.g. for arthritis) as well as making it easier to make that final decision on euthanasia at the end of an animal’s life.

Perhaps we should all be paying very close attention to what’s happening in this area: pets, as dependent beings that cannot communicate their thoughts to their carers, bear some similarities to that growing sector of the aging human population: people with dementia.

In the dystopian future, where the cost of care for the elderly has become unaffordable, is it possible that QOL assessments, derived from veterinary models, could be used as part of the decision making process in human euthanasia?